Surgical instrument mounted display system

ABSTRACT

A C-arm, or a mobile intensifier device, is one example of a medical imaging device that is based on X-ray technology. Because a C-arm device can display high-resolution X-ray images in real time, a physician can monitor progress at any time during an operation, and thus can take appropriate actions based on the displayed images. Monitoring the images, however, is often challenging during certain procedures, for instance during procedures in which attention must be paid to the patient&#39;s anatomy as well as a medical imaging device display. In an example, a surgical instrument assembly includes a processor, a surgical instrument configured to operate on an anatomical structure, and a display coupled to the processor and attached to the surgical instrument. The display can be configured to display visual information comprising X-ray images generated by a medical imaging device.

TECHNICAL FIELD

The present invention relates to systems that can be used in conjunctionwith medical imaging.

BACKGROUND

A C-arm, or a mobile intensifier device, is one example of a medicalimaging device that is based on X-ray technology. The name C-arm isderived from the C-shaped arm used to connect an X-ray source and anX-ray detector with one another. Various medical imaging devices, suchas a C-arm device, can perform fluoroscopy, which is a type of medicalimaging that shows a continuous X-ray image on a monitor. During afluoroscopy procedure, the X-ray source or transmitter emits X-rays thatpenetrate a patient's body. The X-ray detector or image intensifierconverts the X-rays that pass through the body into a visible image thatis displayed on a monitor of the medical imaging device. Because medicalimaging devices such as a C-arm device can display high-resolution X-rayimages in real time, a physician can monitor progress at any time duringan operation, and thus can take appropriate actions based on thedisplayed images. Monitoring the images, however, is often challengingduring certain procedures, for instance during procedures in whichattention must be paid to the patient's anatomy as well as the displayof the medical imaging device. For example, aligning a drill bit to adistal locking hole can be difficult if a medical professional isrequired to maneuver the drill while viewing the display of the medicalimaging device.

SUMMARY

In an example, a surgical instrument assembly includes a processor, asurgical instrument configured to operate on an anatomical structure,and a display coupled to the processor and attached to the surgicalinstrument. The display can be configured to display fluoroscopic data,for instance X-ray images or video data, of the anatomical structure.The fluoroscopic data is generated by an imaging device. The surgicalinstrument assembly can further include a memory in communication withthe processor. The memory can have stored therein instructions that,upon execution by the processor, cause the surgical instrument assemblyto receive in real-time, via a wireless communications channel forexample, the fluoroscopic data from the imaging device. Further, thesurgical instrument can include a proximal end and a working endopposite the proximal end. The working end can be configured to operateon the anatomical structure, and the display can be positioned so as toprovide a line of sight to both the working end and the display from alocation proximal of the surgical instrument. Further still, the displaycan be configured to provide a visual indication of an alignment of acutting instrument of the surgical instrument with respect to adirection of X-ray travel from an X-ray transmitter of the imagingdevice to an X-ray receiver of the imaging device.

In another example, an accelerometer of a surgical instrument assemblyis calibrated with a direction of X-ray travel from an X-ray generatorto an X-ray receiver of a medical imaging device. The surgicalinstrument assembly can include a drill having a drill bit. The surgicalinstrument assembly can display an X-ray image of an anatomicalstructure generated by the medical imaging device. The X-ray image caninclude a target location. A tip of the drill bit can be positioned onthe anatomical structure, and the surgical instrument assembly candisplay a representation of a position of the tip of the drill bit withthe target location. The surgical instrument assembly can furtherdisplay an orientation image that includes a static region and a movableindicator that is representative of an orientation of the drill bit,wherein the drill is oriented with the direction of X-ray travel whenthe movable indicator has a predetermined spatial relationship to thestatic region. A hole can be drilled in the anatomical structure whilethe tip of the drill bit is aligned with the target location, and themovable indicator has the predetermined spatial relationship to thestatic region.

The foregoing summarizes only a few aspects of the present disclosureand is not intended to be reflective of the full scope of the presentdisclosure. Additional features and advantages of the disclosure are setforth in the following description, may be apparent from thedescription, or may be learned by practicing the invention. Moreover,both the foregoing summary and following detailed description areexemplary and explanatory and are intended to provide furtherexplanation of the disclosure.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofexample embodiments of the present disclosure, will be better understoodwhen read in conjunction with the appended drawings. For the purposes ofillustrating the example embodiments of the present disclosure,references to the drawings are made. It should be understood, however,that the application is not limited to the precise arrangements andinstrumentalities shown. In the drawings:

FIG. 1 depicts an example imaging system in accordance with an exampleembodiment, wherein the example imaging system includes an imagingdevice in electrical communication with a surgical instrument assembly.

FIGS. 2A and 2B are perspectives view of the example surgical instrumentassembly depicted in FIG. 1, which includes a display attached to asurgical instrument.

FIG. 2C is a rear elevation view of the example surgical instrumentassembly.

FIG. 2D is a side elevation view of the example surgical instrumentassembly.

FIG. 3 is a block diagram of example computing devices for use in theimaging system shown in FIG. 1.

FIG. 4A depicts an example X-ray image of an anatomical structure thatcan be displayed by the surgical instrument assembly depicted in FIGS.2A-D, wherein the X-ray image includes a target location.

FIG. 4B depicts another example X-ray image of the anatomical structure,showing a position of a cutting instrument of the surgical instrumentassembly relative to the target location of the anatomical structure.

FIG. 4C depicts another example X-ray image of the anatomical structure,wherein a tip of the cutting instrument is positioned over the targetlocation.

FIG. 5A is an example screen shot of the display of the surgicalinstrument assembly, showing a visual indication of an alignment of thecutting instrument with respect to a direction of X-ray travel from anX-ray transmitter to an X-ray receiver of the imaging device, whereinthe cutting instrument is out of alignment with respect to a firstdirection.

FIG. 5B is another example screen shot of the display of the surgicalinstrument assembly, showing the visual indication of the alignment ofthe cutting instrument with respect to the direction of X-ray travel,wherein the cutting instrument is out of alignment with respect to asecond direction that is substantially perpendicular to the firstdirection.

FIG. 5C is another example screen shot of the display of the surgicalinstrument assembly, showing the visual indication of the alignment ofthe cutting instrument with respect to the direction of X-ray travel,wherein the cutting instrument is aligned with the direction of X-raytravel such that the cutting instrument and the direction of X-raytravel have the same orientation.

FIG. 6A depicts the example imaging system shown in FIG. 1, showing anexample anatomical structure and an example orientation of the surgicalinstrument assembly.

FIG. 6B depicts another example orientation of the surgical instrumentassembly in the imaging system shown in FIG. 6A.

DETAILED DESCRIPTION

A medical professional can use a medical imaging device, for instance aC-arm device, to perform various medical procedures on a patient. Forexample, medical professionals can use imaging devices to assess bonefractures, guide surgical procedures, or verify results of surgicalrepairs. C-arm devices, for example, provide spot imaging andfluoroscopic imaging, which allows the generation of continuousreal-time moving images. Such images are provided to a display of theC-arm device. It is recognized herein that, in some cases, the displayof the C-arm system is not positioned in a manner that adequatelyassists a medical professional. In various embodiments described herein,images provided by imaging devices are transmitted in real-time to adisplay that can be mounted to a surgical instrument, such thatfluoroscopic imaging provided by the imaging device can be viewed by amedical professional as the medical professional operates and views aworking end of the surgical instrument. The display can receive theimages in real-time, such that the images are displayed by the displayat the same time that the images are generated by the imaging device. Inone example, the display is mounted to a surgical drill, such thatfluoroscopic images provided by the imaging device can be viewed duringan intramedullary (IM) nailing procedure. In an embodiment, an alignmentapplication can also be rendered by the display mounted to the surgicaldrill, so as to guide the medical professional during the IM nailingprocedure.

As an initial matter, because fluoroscopy is a type of medical imagingthat shows a continuous X-ray image on a monitor, the terms fluoroscopicdata, fluoroscopic image, video data. and X-ray image may h usedinterchangeably herein, without limitation, unless otherwise specified.Thus, an X-ray image may refer to an image generated during afluoroscopic, procedure in which an X-ray beam is passed through theanatomy of a patient. Further, it will be understood that fluoroscopicdata can include an X-ray image, video data, or computer-generatedvisual representations. Thus, fluoroscopic data can include still imagesor moving images.

Referring to FIG. 1, a medical imaging system 102 can include a medicalimaging device 104 and a surgical instrument assembly 202 in electricalcommunication with the imaging device 104. The medical imaging device104, which can be a C-arm device, can include an X-ray generator ortransmitter 106 configured to transmit X-rays through a body (e.g.,bone) and an X-ray detector or receiver 108 configured to receive theX-rays from the X-ray transmitter 106. Thus, the medical imaging device104 can define a direction of X-ray travel 128 from the X-raytransmitter 106 to the X-ray receiver 108. The X-ray transmitter 106 candefine a flat surface 106 a that faces the X-ray receiver 108. Themedical imaging device 104 can further include an arm 110 thatphysically connects the X-ray transmitter 106 with the X-ray receiver108. The medical imaging device 104 can further be communication with amedical imaging device display 112 that is configured to display X-rayimages from the X-ray detector 108. In some cases, the medical imagingdevice display 112 can be hard-wired with the X-ray detector 108, suchthat the display 112 can be in a fixed position relative to the arm 110.

The medical imaging device 104 is presented as a C-arm device tofacilitate description of the disclosed subject matter, and is notintended to limit the scope of this disclosure. Further, the imagingsystem 102 and the imaging device 104 are presented as a medical imagingsystem and a medical imaging device, respectively, to facilitatedescription of the disclosed subject matter, and are not intended tolimit the scope of this disclosure. Thus, it will be appreciated thatother devices, systems, and configurations may be used to implement theembodiments disclosed herein in addition to, or instead of, a systemsuch as the system 102, and all such embodiments are contemplated aswithin the scope of the present disclosure. It is recognized herein thatthe position of the display 112 can create problems for a medicalprofessional. For example, in some cases, the medical professional mayneed to view images or data rendered by the display 112 while viewing apatient positioned between the X-ray generator 106 and the X-raydetector 108. In an example, a medical professional may face challengesplacing distal locking screws during an IM nailing procedure due toinsufficient assistive instruments or guidance systems, such as anaiming Arm used in placement of proximal screws. Distal screws arecommonly inserted in a freehand technique under fluoroscopic guidance.The freehand technique is commonly referred to as the perfect circletechnique. For example, once a perfect circle is established during anIM nailing procedure, it may be difficult to properly align a drill bitto the axis of the distal locking hole due to lack of visibility whileusing radiographic images. Improper alignment can lead to breaching orcracking of an implant during the drilling of a pilot hole, which canresult in implant breakage, poor reduction/fixation, delay of surgery,or the like. It is further recognized herein that an orientation of anX-ray image rendered by the display 112 might not match the orientationof the patient's anatomy, thereby creating further challenges for amedical professional. In various examples described herein, a surgicalinstrument assembly can be configured so as guide and help a medicalprofessional during various operations, such as an IM nailing procedure.

Referring now to FIG. 3, in one embodiment, data (e.g., video or stillimages) provided by the medical imaging device 104 can be received by aninstrument application, for instance a fluoroscopic mirror application,which can be a program, such as a software or hardware or combination ofboth, that can be run on any suitable computing device. A user can usethe instrument application to view images generated by the medicalimaging device 104. The instrument application can receive and displayfluoroscopic images at various locations, for instance at a locationthat is aligned with the view of a patient.

Referring to FIGS. 2 and 3, any suitable computing device 204 can beconfigured to host the instrument application. It will be understoodthat the computing device 204 can include any appropriate device,examples of which include a portable computing device, such as a laptop,tablet, or smart phone. In another example, the computing device 204 canbe internal to the surgical instrument 203.

In an example configuration, the computing device 204 includes aprocessing portion or unit 206, a power supply 208, an input portion210, a display 212, a memory portion 214, a user interface portion 216,and an accelerometer 215. It is emphasized that the block diagramdepiction of computing device 204 is an example and not intended toimply a specific implementation and/or configuration. The processingportion 206, input portion 210, display 212, memory 214, user interface216, and accelerometer 215 can be coupled together to allowcommunications therebetween. The accelerometer 215 can be configured togenerate accelerometer information that corresponds to an orientation ofthe computing device 204. As should be appreciated, any of the abovecomponents may be distributed across one or more separate devices and/orlocations.

In various embodiments, the input portion 210 includes a receiver of thecomputing device 204, a transmitter of the computing device 204, or acombination thereof. The input portion 210 is capable of receivinginformation, for instance fluoroscopic data in real-time, from themedical imaging device 104. As should be appreciated, transmit andreceive functionality may also be provided by one or more devicesexternal to the computing device 204, and thus the surgical instrumentassembly 202.

Depending upon the exact configuration and type of processor, the memoryportion 214 can be volatile (such as some types of RAM), non-volatile(such as ROM, flash memory, etc.), or a combination thereof. Thecomputing device 204 can include additional storage (e.g., removablestorage and/or non-removable storage) including, but not limited to,tape, flash memory, smart cards, CD-ROM, digital versatile disks (DVD)or other optical storage, magnetic cassettes, magnetic tape, magneticdisk storage or other magnetic storage devices, universal serial bus(USB) compatible memory, or any other medium which can be used to storeinformation and which can be accessed by the computing device 204.

The computing device 204 also can contain the user interface portion 216allowing a user to communicate with the computing device 204. The userinterface 216 can include inputs that provide the ability to control thecomputing device 204, via, for example, buttons, soft keys, a mouse,voice actuated controls, a touch screen, movement of the computingdevice 204, visual cues (e.g., moving a hand in front of a camera on thecomputing device 204), or the like. The user interface portion 216 canprovide outputs, including visual information (e.g., via a display),audio information (e.g., via speaker), mechanically (e.g., via avibrating mechanism), or a combination thereof. In variousconfigurations, the user interface portion 216 can include a display, atouch screen, a keyboard, a mouse, an accelerometer, a motion detector,a speaker, a microphone, a camera, a tilt sensor, or any combinationthereof. The user interface portion 216 can further include any suitabledevice for inputting biometric information, such as, for example,fingerprint information, retinal information, voice information, and/orfacial characteristic information. Thus, a computer system such as thecomputing device 204 can include a processor, a display coupled to theprocessor, and a memory in communication with the processor. The memorycan have stored therein instructions that, upon execution by theprocessor, cause the computer system to perform operations, such as theoperations described herein. The display 212 can be configured todisplay visual information, such as described with reference to FIGS.4A-C and FIGS. 5A-C.

Referring to FIGS. 1 and 3, a transmitter unit 114 can be electricallycoupled to, or can be part of, the medical imaging device 104. Thetransmitter unit 114 can be any suitable computing device configured toreceive and send images, for instance video signals includingfluoroscopic images. It will be understood that the transmitter unit 114can include any appropriate device, examples of which include a portablecomputing device, such as a laptop, tablet, or smart phone.

Referring in particular to FIG. 3, in an example configuration, thetransmitter unit 114 can include a processing portion or unit 116, apower supply 118, an input portion 120, and an output portion 122. It isemphasized that the block diagram depiction of transmitter unit 114 isan example and not intended to imply a specific implementation and/orconfiguration. The processing portion 116, input portion 120, and outputportion 122 can be coupled together to allow communicationstherebetween. As should be appreciated, any of the above components maybe distributed across one or more separate devices and/or locations.

In various embodiments, the input portion 120 includes a receiver of thetransmitter unit 114, and the output portion 122 includes a transmitterof the transmitter unit 114. The input portion 120 is capable ofreceiving information, for instance fluoroscopic images or video data,from the medical imaging device 104, in particular an output interface105 of the medical imaging device 104. The output interface 105 caninclude a coaxial output, a usb output, a component output, a wirelessoutput, or the like. As should be appreciated, transmit and receivefunctionality may also be provided by the medical imaging device 104. Inan example, the transmitter unit 114 is electrically coupled to theoutput interface 105 of the medical imaging device 104, so as toestablish a wired or wireless electrical connection between thetransmitter unit 114 and the display 112. The output interface 105 caninclude or more video output connectors using the matching input module.In an example, the processing portion 116, which can include or moreprocessors running on an embedded operating system, can detect thepresence of a signal, for instance a video signal including fluoroscopicimages, from the medical imaging device 104. The processing portion 116can process the signal as necessary for transmitting to the surgicalinstrument assembly 202. For example, the processing portion 116 cancompress the signal so as to reduce the bandwidth that is used fortransmitting the signal.

After the processing portion 116 performs processing on the videosignal, as necessary, the video signal that can include fluoroscopicimages can be sent by the output portion 122 of the transmitter unit 114to the input portion 210 of the computing device 204. The output portion122 of the transmitter unit 114 can be configured to transmitfluoroscopic images in accordance with any communication protocol asdesired. For example, the output portion 122 can include a ZigBee moduleconnected to the processing portion 206 via a universal serial bus(USB), such that the output portion 122 can send data wirelessly (via awireless communications channel) in accordance with any ZigBee protocol.The output portion 122 can send video signals, for instance fluoroscopicimages, over Wi-Fi, Bluetooth, broadcast, or any other wirelesscommunication channels as desired.

Accordingly, the input portion 210 of the device 204 can receive videosignals in real-time, for instance fluoroscopic images, which are sentvia a wireless communication channel from the medical imaging device104. The input portion 210 can be configured to receive ZigBee messages,Wi-Fi messages, Bluetooth messages, broadcast messages, or messagesformatted in accordance with any wireless protocol as desired. In anexample, when the input portion 210 of the device 204 receives thefluoroscopic images from the medical imaging device 104, the images canbe retrieved and verified by the processing portion 206 of the computingdevice 204. For example, the processing portion 206 can verify that thereceived images are from the appropriate medical imaging device. Theimages can be forwarded to the display 212, for example, when the imagesare verified. The processing portion 206 can also ensure that valid datais displayed. For example, if there is an interruption to the wirelesscommunication channel or connection between the computing device 204 andthe medical imaging device 104, the processing portion 206 can identifythe interruption, and send a message to the display 212 so that theinterruption is conveyed to a medical professional who views the display212. In some cases, the processor 206 can cause the surgical instrumentassembly 202 to display an indication of error on the display 212 when aquality of the communication link between the imaging device 104 and thesurgical instrument assembly 202 is below a predetermined threshold.Thus, a wireless point-to-point communication channel or connectionbetween the transmitter unit 114 and the computing device 204 can beestablished, and the wireless point-to-point connection can be managedby the input portion 210 and the output portion 122 on the physicallayer, and the processing portions 116 and 206 at the application layer.

Referring now to FIGS. 2A-D, the medical imaging system 102 can includethe surgical instrument assembly 202 that can include the computingdevice 204 mounted to a surgical instrument 203. The surgical instrument203 can be configured to operate on an anatomical structure, such as ananatomical structure 124. The surgical instrument 203 can define a body205, and the computing device can be attached anywhere to the body 205as desired. In an example, the computing device 204, and thus thedisplay 212, can be supported by a mount 228. The mount 228 can includea support surface 230 that supports the computing device 204, and thusthe display 212. The mount 228 can further include an arm 232 attachedto the support surface 230 and the body 205 of the surgical instrument203, such that the display 212 is in a fixed position relative to thebody 205 of the surgical instrument 203. The arm 232 or the supportsurface 230 can be configured to rotate, so as to adjust the viewingangle of the display 212. The mount 228 can be positioned such that thedisplay does not interfere with the operation of the surgical instrument203. It will be understood that the computing device 204 can bealternatively mounted to the surgical instrument 205 as desired. It willalso be understood that the computing device 204 can alternatively bemonolithic to the surgical instrument 203. Further, though the surgicalinstrument 203 is depicted as a surgical drill for purposes of example,it will be appreciated that the computing device 204 can be mounted to,or can be monolithic with, numerous suitable alternative equipment orinstruments. For example, the surgical instrument assembly 202 caninclude an instrument or equipment configured to target an area of boneor other part of the anatomy, remove a medical implant, perform anosteotomy, or any other procedure, for instance any other procedureusing fluoroscopy, as desired. Thus, although the anatomical structure124 is presented as a bone, it will be understood that structures onwhich the surgical instrument assembly can be configured to operate arenot limited to bones.

The computing device 204, and thus the surgical instrument assembly 202,can include the display 212 that can be attached to the surgicalinstrument. The display 212 can be configured to display fluoroscopicimages of the anatomical structure 124 that are generated by the imagingdevice 104. In an example configuration, the display 212 can displayfluoroscopic images of the anatomical structure 124 in real-time, suchthat the images of the anatomical structure 124 are displayed by thedisplay 212 at the same time that the images are generated by theimaging device 104. In some cases, the display 212, and thus thesurgical instrument assembly 202, can include a plurality of displays,for instance a first display 212 a and a second display 212 b that has adifferent orientation as compared to an orientation of the first display212 a. In another example configuration, the display 212, and thus thesurgical instrument assembly 202, includes only one display.

With continuing reference to FIGS. 2A-D, the surgical instrument 203 candefine a proximal end 203 b and a working end 203 a opposite theproximal end 203 b. The working end 203 a can be configured to operateon, for instance cut, drill, or otherwise target, a structure, forinstance the anatomical structure 124, of a medical patient. The display212, in particular the first display 212 a and the second display 212 b,can be positioned so as to provide a line of sight to both the workingend 203 a and the display 212 from a location proximate of the surgicalinstrument 203. Thus, in some cases, for example, a medical professionalcan, while operating the surgical instrument 203, view both the display212 and the working end 203 a of the surgical instrument 203.

In an example, the surgical instrument 203 includes a cutting instrument226 that includes a proximal end 226 b adjacent to the body 205 of thesurgical instrument 203, and a cutting tip 226 a opposite the proximalend 226 b of the cutting instrument 226. The cutting tip 226 a candefine a terminal end of the cutting instrument that is opposite to theproximal end 226 b of the cutting instrument 226. The cutting instrument226 can have the cutting tip 226 a that can be configured to removeanatomical material from an anatomical structure, for instance theanatomical structure 124. In the illustrated example, the cuttinginstrument 226 is a drill bit, and the cutting tip 226 a is a tip of thedrill bit, though it be appreciated that other instruments andconfigurations may be used to implement the embodiments disclosed hereinin addition to, or instead of, an instrument such as the cuttinginstrument 226, and all such embodiments are contemplated as within thescope of the present disclosure.

The surgical instrument assembly 202 can include an alignment tool 218,for instance an axis alignment tool, mounted to the body 205 of thesurgical instrument 203. It will be understood that the alignment tool218 can alternatively be monolithic to the surgical instrument 203. Thealignment tool 218 can be rigidly attached to the body 205 of thesurgical instrument 203. In an example, the cutting instrument 226 islocated at the working end 203 a of the surgical instrument 203, and thealignment tool 218 is located at the proximal end 203 b of the surgicalinstrument, though it will be understood that that the alignment tool218 can be alternatively located as desired. The alignment tool 218 candefine a first surface 218 a proximate to the surgical instrument 203and a second surface 218 b opposite the first surface 218 a. The secondsurface 218 b can define a flat surface, and thus the alignment tool 218can define a flat surface. Thus, the second surface 218 b of thealignment tool 218 can define a plane. The cutting instrument 226 (e.g.,drill bit) can be oriented perpendicularly to the plane defined by thesecond surface 218 b of the alignment tool 218. In an example, thealignment tool 218 includes a pin that is oriented perpendicularly tothe plane defined by the second surface 218 b of the alignment tool. Thepin can be configured to be received by a hole defined by the proximalend 203 b of the surgical instrument 203. The hole defined by theproximal end 203 b of the surgical instrument 203 can have a parallelorientation with the cutting instrument 226, such that, when the pin ofthe alignment tool 218 is received by the hole defined by the proximalend 203 b of the alignment tool 218, the second surface 218 b of thealignment tool defines the plane that is perpendicular to theorientation of the cutting instrument 226.

Referring also to FIGS. 4A-C, fluoroscopic images of the anatomicalstructure 124 can include one or more target locations 126. The targetlocations 126 can represent locations on the anatomical structure 124that the surgical instrument 203 can drill, cut, or otherwise target. Inaccordance with the illustrated example, the target locations 126 can bedefined by an implant 125, for instance an IM nail or rod, in a bone. Itwill be understood that an example operation performed by the surgicalinstrument assembly is presented as an IM nailing operation tofacilitate description of the disclosed subject matter, and the exampleIM operation is not intended to limit the scope of this disclosure.Thus, it will be appreciated that the surgical instrument assembly 202may be used to perform other operations in addition to, or instead of,an operation such as the example IM nailing operation, and all suchembodiments are contemplated as within the scope of the presentdisclosure.

The display 212 can display fluoroscopic images associated with IMnailing operations, among others. The display 212 can be configured todisplay fluoroscopic images, for instance example fluoroscopic images400 a-c of the anatomical structure 124, generated by, and receivedfrom, the medical imaging device 104. Referring in particular to FIG.4A, the display 212, for instance the first display 212 a, can displaythe example fluoroscopic image 400 a, of the implant 125 in theanatomical structure 124. The implant 125 can define one or more targetlocations 126 at which material can be removed from the anatomicalstructure 124. In an example IM nailing operation, by viewing thedisplay 212 that displays fluoroscopic images from the imaging device104, a medical professional can maneuver the patient or the imagingdevice 104 while viewing the patient and display 212 simultaneously,until the target locations 126 define perfect circles, as illustrated inFIG. 4A. In the IM nailing example, when the one or more targetlocations 126 define perfect circles, holes can be drilled at the targetlocations 126 for locking screws.

Referring now to FIG. 4B, the display 212 can display the examplefluoroscopic image 400 b. Thus, the display 212 can be configured todisplay a position of the cutting tip 226 a of the cutting instrument226 relative to the target location 126 on the fluoroscopic images ofthe anatomical structure 124. The fluoroscopic image 400 b can depict,for example, the position of the cutting tip 226 a that is shown in FIG.6B. The cutting tip 226 a can be configured to remove anatomicalmaterial from the one or more target locations 126 of the anatomicalstructure 124. Further, as shown in FIG. 4C, the tip 226 a of thecutting instrument 226 (e.g., drill bit) can be positioned on theanatomical structure 124, for instance at the center of the targetlocation 126. The display 212 can be positioned so as to provide a lineof sight to both the tip 226 a and the display 212 from a locationproximate of the surgical instrument 203, such that a medicalprofessional can view both the fluoroscopic images 400 b and 400 c, andthus the tip 226 a, and the anatomical structure 124, so as to centerthe tip 226 a at the target location 126. The display 212 of thesurgical instrument 203 can mirror the display 112 of the medicalimaging device 104, such that the display 212 of the surgical instrumentassembly 202 can render the same images that the display 112 of theimaging device 104 renders at the same time, so as to display images inreal-time.

In some cases, for instance based on a user selection via the userinterface 216, the surgical instrument assembly 202 can rotate thedisplayed fluoroscopic images on the display 212 to a rotatedorientation such that a vertical or horizontal direction on the display212 corresponds with a vertical or horizontal direction, respectively,of movement of the surgical instrument 203 relative to the anatomicalstructure 124. Thus, in some cases, the fluoroscopic images in therotated orientation that are displayed by the display 212 can be rotatedas compared to the fluoroscopic images displayed on the medical imagingdevice display 112 that is separate from the display 212 that is coupledto the surgical instrument 203.

Referring now to FIGS. 5A-C, the display 212 can also be configured toprovide a visual indication, for instance an orientation image 129, ofan alignment of the cutting tip 226 a with respect to the direction ofX-ray travel 128 from the X-ray transmitter 106 to the X-ray receiver108. In an example, the display 212 includes the first display 212 a andthe second display 212 b, and the first display 212 a is configured todisplay fluoroscopic images (e.g., fluoroscopic images 400 a-c) from theimaging device 104, and the second display 212 b is configured todisplay orientation screens (e.g., orientation screens 500 a-c) thatinclude a visual indication of an orientation of the cutting instrument226. It will be understood that the first display 212 a can also, oralternatively, display orientation screens, and the second display 212 bcan also, or alternatively, display fluoroscopic images. Further, thedisplay 212 can, in some cases, include only one display, which candisplay both fluoroscopic images and orientation screens. In an example,a user can select an option via the user interface 216 to select whichof the fluoroscopic images or orientation screens are displayed by thedisplay 212. In another example, the display 212 can be separated, forinstance split in half, such that both the fluoroscopic images and theorientation screens can be displayed by the display 212 at the sametime.

The visual indication of alignment, for instance the orientation image129, can be based on the direction of X-ray travel 128, and can furtherbe based on accelerometer information that corresponds to an orientationof the cutting instrument 226. For example, the accelerometer 215 of thesurgical instrument assembly 202 can be calibrated with the direction ofX-ray travel 128 travel from the X-ray generator 106 to the X-rayreceiver 108 of the medical imaging device 104. In an examplecalibration, the alignment tool 218 that is attached to the surgicalinstrument 203 is configured to register with a surface of the medicalimaging device 104 that has a predetermined orientation so as to alignthe cutting instrument 226 (e.g., drill bit) with the direction of X-raytravel 128. In one example, the alignment tool 218 is configured toregister with the flat surface 106 a of the X-ray transmitter, though itwill be understood that the alignment tool 218 can be configured toregister with other surfaces of the medical imaging device 104 asdesired. In particular, the second surface 218 b of the alignment tool218 can be a flat surface that can abut the flat surface 106 a of themedical imaging device 104 when the cutting instrument 226 is alignedwith the direction of X-ray travel 128. Continuing with the example, azero value can be set when the surface 218 b of the alignment tool 218abuts the flat surface 106 a of the X-ray generator 106, so as tocalibrate the accelerometer 215 with the medical imaging device 104, inparticular the direction of X-ray beams generated by the medical imagingdevice 104. In one example, to set the zero value, thereby calibratingthe accelerometer 215 with the direction of X-ray travel 128, a user canactuate a calibration option 134 on the display 212 when the surface 218b of the alignment tool is flat against the flat surface 106 a of theX-ray generator 106, such that the zero value is set when the cuttinginstrument 226 is oriented along the direction of X-ray travel 128.

In another example, a calibration instrument can be part of, or attachedto, the medical imaging device 104. When the medical imaging device 104,and in particular the direction of X-ray travel 128, is oriented in thedesired position to perform an operation, the calibration instrument ofthe medical imaging device can identify a zero value relative togravity, such that the zero value corresponds to the desired directionof X-ray travel 128. The calibration instrument 128 of the medicalimaging device 104 can send the zero value relative to gravity to theaccelerometer 215. The accelerometer 215 can set its zero value relativeto gravity to the zero value that it receives from the calibrationinstrument of the medical imaging device 104, thereby calibrating theaccelerometer 215 with the direction of X-ray travel 128. Thus, theaccelerometer 215 can indicate the zero value when the cuttinginstrument 226 is oriented along the direction of X-ray travel 128.

In an example, the accelerometer 215 corresponds to an orientation ofthe display 212. Thus, in some cases, when the orientation of thedisplay 212 with respect to the cutting instrument 226 is adjusted, thezero value is re-set to re-calibrate the accelerometer 215 with thedirection of X-ray travel 128. In some examples, the display 212 has oneor more preconfigured orientations (e.g., 90 degrees, 75 degrees, etc.)with respect to the cutting instrument 226. Thus, in some cases, aftercalibration at a first preconfigured orientation, the display 212 can bemoved to a second preconfigured orientation. In an example, the user canselect, using the user interface 216, the preconfigured orientation atwhich the display 212 is positioned. The accelerometer 215 can receivethe second preconfigured orientation, and adjust the zero valueaccordingly, such that the display 212 is adjusted without theaccelerometer being re-calibrated. In yet another example, the medicalimaging device 104 includes an accelerometer that can identify a changein orientation of the direction of X-ray travel. In this example, theaccelerometer of the medical imaging device can send the change inorientation of the direction of X-ray travel to the surgical instrumentassembly 202, such that the zero value can be re-set withoutre-calibrating the accelerometer 215. Thus, the zero value can beadjusted in accordance with a change in the orientation of the X-raygenerator 106 and X-ray receiver 108.

When the accelerometer 215 of the surgical instrument assembly 202 iscalibrated with the direction of X-ray travel, for example, theaccelerometer can generate accelerometer information that indicates anorientation of the cutting instrument 226 relative to the direction ofX-ray travel 128. The accelerometer information can be displayed by thedisplay 212 in various orientation screens, for instance orientationscreens 500 a-c, which can include the orientation image 129. By way ofan IM nailing example, by viewing the orientation image 129 while usingthe surgical instrument assembly 202, the cutting instrument 226 can bemaintained at the proper orientation while drilling. That is, holes canbe drilled at the target locations 126 that define perfect circles.

For example, referring to FIGS. 5A-5C, the orientation screens 500 a-ccan include the orientation image 129 that can include a static region130 and a movable indicator 132. The movable indicator 132 can berepresentative of the orientation of the cutting instrument 226. In anexample, the cutting instrument 226 is oriented with the direction ofX-ray travel 128 when the movable indicator 132 has a predeterminedspatial relationship to the static region 130. In an example, a hole isdrilled in the anatomical structure 124 while the tip 226 a of thecutting instrument 226 (e.g., drill bit) is aligned with the targetlocation 126, and the movable indicator 132 has the predeterminedspatial relationship to the static region 130. It will be understoodthat the predetermined spatial relationship can vary as desired. In somecases, for example, the cutting instrument 226 is oriented with thedirection of X-ray travel 128 when the movable indicator 132 overliesthe static region 130. In some cases, as shown in FIG. 5C, the cuttinginstrument 226 is oriented with the direction of X-ray travel 128 whenthe movable indicator 132 is within a boundary defined by the staticregion 130.

Thus, in operation, the display 212 can receive and display a pluralityof X-ray images in real-time, and the display 212 can display theorientation image 129 as the surgical instrument 203 is operated. In anexample, referring to FIG. 6A, the surgical instrument 203 can beoperated along a first direction D1 that is parallel to the direction ofX-ray travel 128, so as to drill hole along the first direction D1.During drilling, for example, as the orientation of the cuttinginstrument 226 moves away from the zero value, the movable indicator 132can move away from the static region 130. The movable indicator 132 canmove relative to the static region 130 at the same time that theorientation of the cutting instrument 226 moves relative to the zerovalue, such that the movable indicator 132 provides a real-timerepresentation of the orientation of the cutting instrument 226. Forexample, as the proximal end 226 b of the cutting instrument 226 movesalong a second direction D2 relative to the cutting tip 226 a of thecutting instrument 226, the movable indicator 132 can move along thesecond direction D2 (e.g., see FIG. 5A). The second direction D2 can beperpendicular to the first direction D1. Similarly, as the proximal end226 b of the cutting instrument 226 moves along a third direction D3relative to the cutting tip 226 a of the cutting instrument 226, themovable indicator 132 can move along the third direction D3 (e.g., seeFIG. 5B). The third direction D3 can be perpendicular to both the firstand second directions D1 and D2, respectively. Further, it will beunderstood that as the proximal end 226 b of the cutting instrument 226moves along both the second and third directions relative to the cuttingtip 226 a of the cutting instrument 226, the movable indicator 132 canmove along both the second and third directions D3. Further, theorientation screens 500 a-c can include a numerical representation 136of the orientation of the cutting instrument 226 along the second andthird directions D2 and D3.

Referring in particular to FIG. 5C, when the cutting instrument 226 isoriented in accordance with the zero value, the movable indicator 132can be positioned within a boundary defined by the static region 130.Further, in some cases, when the cutting instrument 226 is preciselyaligned with the direction of X-ray travel 128, the numericalrepresentation 136 may indicate that zero values associated with boththe second and third directions. By way of an IM nailing example, amedical professional can maintain the orientation image 129 illustratedin FIG. 5C while drilling, so as to drill holes having the appropriateorientation at the target locations 126.

While example embodiments of devices for executing the disclosedtechniques are described herein, the underlying concepts can be appliedto any computing device, processor, or system capable of communicatingand presenting information as described herein. The various techniquesdescribed herein can be implemented in connection with hardware orsoftware or, where appropriate, with a combination of both. Thus, themethods and apparatuses described herein can be implemented, or certainaspects or portions thereof, can take the form of program code (i.e.,instructions) embodied in tangible non-transitory storage media, such asfloppy diskettes, CD-ROMs, hard drives, or any other machine-readablestorage medium (computer-readable storage medium), wherein, when theprogram code is loaded into and executed by a machine, such as acomputer, the machine becomes an apparatus for performing the techniquesdescribed herein. In the case of program code execution on programmablecomputers, the computing device will generally include a processor, astorage medium readable by the processor (including volatile andnon-volatile memory and/or storage elements), at least one input device,and at least one output device, for instance a display. The display canbe configured to display visual information. For instance, the displayedvisual information can include fluoroscopic data such as X-ray images,fluoroscopic images, orientation screens, or computer-generated visualrepresentations.

The program(s) can be implemented in assembly or machine language, ifdesired. The language can be a compiled or interpreted language, andcombined with hardware implementations.

The techniques described herein also can be practiced via communicationsembodied in the form of program code that is transmitted over sometransmission medium, such as over electrical wiring or cabling, throughfiber optics, or via any other form of transmission. When implemented ona general-purpose processor, the program code combines with theprocessor to provide a unique apparatus that operates to invoke thefunctionality described herein. Additionally, any storage techniquesused in connection with the techniques described herein can invariablybe a combination of hardware and software.

While the techniques described herein can be implemented and have beendescribed in connection with the various embodiments of the variousfigures, it is to be understood that other similar embodiments can beused or modifications and additions can be made to the describedembodiments without deviating therefrom. For example, it should beappreciated that the steps disclosed above can be performed in the orderset forth above, or in any other order as desired. Further, one skilledin the art will recognize that the techniques described in the presentapplication may apply to any environment, whether wired or wireless, andmay be applied to any number of such devices connected via acommunications network and interacting across the network. Therefore,the techniques described herein should not be limited to any singleembodiment, but rather should be construed in breadth and scope inaccordance with the appended claims.

What is claimed:
 1. A surgical instrument assembly comprising: asurgical instrument configured to operate on an anatomical structure,the surgical instrument including a cutting tip configured to removeanatomical material from a target location of the anatomical structure;an imaging device configured to acquire fluoroscopic image data of theanatomical structure; a processor, in communication with anon-transitory computer-readable memory medium having therein storedinstructions when executed by the processor, causes the surgicalinstrument assembly to wirelessly receive the fluoroscopic image data ofthe anatomical structure from the imaging device; a display coupled tothe processor and attached to the surgical instrument, the displayconfigured to receive and display the acquired fluoroscopic image dataof the anatomical structure, wherein the display is configured todisplay a position of the cutting tip relative to the target location onthe fluoroscopic image data of the anatomical structure, and the displayis further configured to provide a predetermined visual indication whenthe surgical instrument is coincidentally aligned direction of X-raytravel from an X-ray transmitter of the imaging device to an X-rayreceiver of the imaging device, wherein the surgical instrument is adrill having a drill bit, and the surgical instrument assembly furthercomprises an alignment tool that is attached to the surgical instrumentand is configured to register with a surface of the medical imagingdevice that has a predetermined orientation so as to coincidentallyalign the drill bit with a direction of X-ray travel from a X-raytransmitter of the imaging device to a X-ray receiver of the imagingdevice, and wherein the alignment tool defines a flat surface configuredto abut the surface of the medical imaging device when the drill bit iscoincidentally aligned with the direction of X-ray travel, and the flatsurface defines a plane such that the drill bit is orientedperpendicularly to the plane.
 2. The surgical instrument assembly asrecited in claim 1, wherein the surgical instrument comprises a proximalend and a working end opposite the proximal end, wherein the working endis configured to operate on the anatomical structure, and the display ispositioned so as to provide a line of sight to both the working end andthe display from a location proximal of the surgical instrument.
 3. Thesurgical instrument assembly as recited in claim 1, wherein the visualindication of the alignment is based on information from anaccelerometer that corresponds to an orientation of the surgicalinstrument, wherein the accelerometer is calibrated to the direction ofX-ray travel.
 4. The surgical instrument assembly as recited in claim 3,wherein the surgical instrument assembly further comprises a computingdevice mounted to the surgical instrument, the computing devicecomprising the processor, display, memory, and an accelerometerconfigured to generate the accelerometer information, the accelerometerinformation further corresponding to an orientation of the computingdevice.
 5. The surgical instrument assembly as recited in claim 1, thememory having further stored therein instructions that, upon executionby the processor, cause the surgical instrument assembly to display anindication of error on the display when a quality of a communicationlink between the imaging device and the surgical instrument assembly isbelow a predetermined threshold.
 6. The surgical instrument assembly asrecited in claim 1, the memory having further stored thereininstructions that, upon execution by the processor, cause the surgicalinstrument assembly to rotate the displayed fluoroscopic data on thedisplay to a rotated orientation such that a vertical direction on thedisplay corresponds with a vertical direction of movement of thesurgical instrument relative to the anatomical structure.
 7. Thesurgical instrument assembly as recited in claim 6, wherein the imagingdevice is further in communication with an imaging device displayseparate from the display that is coupled to the surgical instrument,and the fluoroscopic data in the rotated orientation are rotated ascompared to fluoroscopic data displayed on the imaging device display.8. A method comprising instructions stored on a non-transitory memorycomputer-readable medium in communication with a processor configured toexecute the instructions stored on the non-transitory computer-readablememory medium, the processor executing steps of the instructions:receiving, via a wireless communications channel, a plurality offluoroscopic images generated by a medical imaging device that isconfigured to transmit X-rays in a direction of X- ray travel;displaying, by a display attached to a surgical instrument having acutting instrument, the plurality of fluoroscopic images; displaying, bythe display, an orientation image that includes a static region and amovable indicator that is representative of an orientation of thecutting instrument; as the orientation of the cutting instrument movesaway from a zero value, moving the moveable indicator away from thestatic region, wherein the zero value represents a coincidentalalignment of the orientation of the cutting instrument with thedirection of X-ray travel of the X-rays; when the cutting instrument isoriented in accordance with the zero value, positioning the moveableindicator within a predetermined boundary defined by the static region,wherein the surgical instrument is a drill and the cutting instrument isa drill bit, and the surgical instrument assembly further comprises analignment tool that is attached to the surgical instrument and isconfigured to register with a surface of the medical imaging device thathas a predetermined orientation so as to coincidentally align the drillbit with a direction of X-ray travel from a X-ray transmitter of theimaging device to a X-ray receiver of the imaging device, and whereinthe alignment tool defines a flat surface configured to abut the surfaceof the medical imaging device when the drill bit is aligned with thedirection of X-ray travel, and the flat surface defines a plane suchthat the drill bit is oriented perpendicularly to the plane.
 9. Themethod as recited in claim 8, further comprising the step of adjustingthe zero value in accordance with a change in the orientation defined bythe X-ray generator and the X-ray receiver.
 10. The method as recited inclaim 8, further comprising the step of calibrating the cuttinginstrument to achieve the zero value.
 11. The method of claim 10,wherein the calibrating step comprises abutting a planar surfacesupported by the surgical instrument against a planar surface of themedical imaging device, such that an accelerometer of the cuttinginstrument is aligned with the direction of X-ray travel.
 12. The methodof claim 8, wherein the first displaying step comprises displaying thefluoroscopic image including a bone, an intramedullary nail disposed ina medullary canal of the bone, and the cutting instrument, showing arelative position between the cutting instrument and a hole of theintramedullary nail.
 13. The surgical instrument assembly as recited inclaim 12, wherein the surgical instrument is a drill having a drill bit,the method comprising the step of drilling into the bone toward the holewhen 1) the drill bit is aligned with the hole on the fluoroscopic imageand 2) the cutting instrument is oriented in accordance with the zerovalue.
 14. A method comprising the instructions stored on anon-transitory memory computer-readable medium in communication with aprocessor configured to execute the instructions stored on thenon-transitory computer-readable memory medium, the processor executingsteps of the instructions: receiving, via a wireless communicationschannel, a plurality of fluoroscopic images generated by a medicalimaging device; displaying, by a display attached to a surgicalinstrument having a cutting instrument, theplurality of fluoroscopicimages; displaying, by the display, an orientation image that includes astatic region and a movable indicator that is representative of anorientation of the cutting instrument; as the orientation of the cuttinginstrument moves away from a zero value, moving themoveable indicatoraway from the static region; and when the cutting instrument is orientedin alignment with the zero value, positioning themoveable indicatorwithin a boundary defined by the static region, wherein the zero valuerepresents a predetermined orientation defined by the alignment of thecutting instrument with a direction of X-ray travel transmitted from anX-ray generator and received by a X-ray receiver that generates theplurality of X-ray images, the method further comprising, adjusting thezero value in accordance with a change in the orientation defined by theX-ray generator and the X-ray receiver, wherein the surgical instrumentis a drill and the cutting instrument is a drill bit, and the surgicalinstrument assembly further comprises an alignment tool that is attachedto the surgical instrument and is configured to register with a surfaceof the medical imaging device that has the predetermined orientation soas to coincidentally align the drill bit with a direction of X-raytravel from the X-ray transmitter of the imaging device to the X-rayreceiver of the imaging device, and wherein the alignment tool defines aflat surface configured to abut the surface of the medical imagingdevice when the drill bit is aligned with the direction of X-ray travel,and the flat surface defines a plane such that the drill bit is orientedperpendicularly to the plane.
 15. The surgical instrument assembly asrecited in claim 1, wherein the direction of X-ray travel is a currentdirection of X-ray travel from the X-ray transmitter to the X-rayreceiver.
 16. The method as recited in claim 8, wherein the direction ofX-ray travel is a current direction of X-ray travel of the X-rays. 17.The method as recited in claim 14, wherein the zero value represents analignment of the orientation of the cutting instrument with a currentdirection of X-ray travel of X-rays generated by the X-ray generator andreceived by the X-ray receiver.